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Incontinence - Urinary and Fecal. NPN 200 Medical Surgical Nursing I. Urinary Incontinence. USA- 13 million (85% women) Stress incontinence - most common type Loss of urine when, sneezing, jogging or lifting Common after childbirth and menopause Urge incontinence

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incontinence urinary and fecal

Incontinence - Urinary and Fecal

NPN 200

Medical Surgical Nursing I

urinary incontinence
Urinary Incontinence
  • USA- 13 million (85% women)
    • Stress incontinence - most common type
      • Loss of urine when, sneezing, jogging or lifting
      • Common after childbirth and menopause
    • Urge incontinence
      • Inability to suppress the urge to void, may be caused by infection, stroke,, etc.
    • Overflow incontinence
      • Occurs when the muscles in the bladder do not contract and the bladder becomes distended over its capacity
    • Functional incontinence – lack of awareness
causes of incontinence
Causes of Incontinence
  • Medications - CNS depressants, diuretics, multiple medications
  • Disease – CVA’s, arthritis, Parkinson’s
  • Depression – decreases energy to remain continent, decreasing self worth decreases desire to remain continent
  • Inadequate resources – glasses, canes, may be afraid to ambulate, products to manage are costly, and no one available to help to bathroom
assessment
Assessment
  • Questions – Do you leak urine when you cough or sneeze, on the way to the bathroom, or do you wear pads, tissue or use cloths to catch leaking urine?
  • Have patient describe the pattern and volume of urine, and any related symptoms
  • May observe a stale urine odor
  • Assess for distention, may need post void residual, have patient cough while wearing a pad
  • Clean catch urine, post void residual CBC
  • Voiding cystogram, cystoscope , cystometry, uroflowmetry
medical treatment
Medical Treatment
  • Surgery to improve the tone of the sphincter, artificial sphincters, repair cystocele (anterior vaginal repair), retropubic suspension, pubovaginal sling, or other means such as collagen injections
  • Non-surgical management
    • Drug interventions
    • Behavioral interventions
    • Intermittent catheterization
    • Indwelling catheter
    • Penile clamps
    • Pelvic organ support devices (pessary)
interventions
Interventions
  • Urinary bladder training
    • Improves bladder function by increasing the bladders ability to hold urine and the clients ability to hold urine and suppress urination
  • Urinary habit training
    • Establishes a predictable pattern of bladder emptying to prevent incontinence for patients who have urge, stress, or functional incontinence
  • Urinary catheterization – intermittent – regular periodic use of a catheter to empty bladder
  • Teach use of incontinent products
potential complications of urinary incontinence
Potential Complications of Urinary Incontinence
  • Impaired skin integrity
  • Risk for infection
  • Social isolation
  • Low self esteem
fecal incontinence
Fecal Incontinence
  • Less common
  • Caused by trauma, sphincter dysfunction, childbirth, Crohn’s disease, or diabetic neuropathy
  • Severe diarrhea may cause temporary incontinence
  • May also be R/T impaction
fecal incontinence9
Fecal Incontinence
  • Types
    • Symptomatic
      • Usually R/T colorectal disease/may have blood or mucus

Overflow

      • Caused by constipation, where the feces fills the entire colon
      • Patient passes semi-formed stool frequently
      • Can be seen in patients with long term laxative use
      • Treat by cleansing over 7-10 days, then work on constipation
    • Neurogenic
      • Patients who do not voluntarily delay defecation
      • Usually with dementia
    • Anorectal
      • Nerve damage which weakens muscles in the pelvic floor
      • Have several incontinent stools per day
nursing assessment
Nursing Assessment
  • What is the problem?
  • Identify bowel patterns
  • Identify characteristics
    • Color
    • Clarity
    • Consistency
  • Past problems
  • Perform physical exam
    • Inspect rectal area
treatment interventions
Treatment/Interventions
  • Provide for regular, scheduled bowel emptying (usually 30 min after eating)
  • Give ordered laxatives or enema’s
  • Teach dietary and fluid requirements
  • Encourage ambulation or activity as tolerated
  • Cleanse and protect perineum after each BM
  • Use depends or fecal pouches when necessary
  • Always encourage patient and be prompt in attending to needs